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I agree with the collection, storage and use of my above mentioned personal data for the purpose of information and contact. The data will be used exclusively by MVZ PAN Institut fr endokrinologie & reproduktionsmedizin GmbH as well as the respective medical practice in the house, according to the medical need and contact request.
 
I hereby confirm that my/our information is correct. I/we declare that I/we agree that, in the context of the working group of the "MVZ PAN Institute of Endocrinology and Reproductive Medicine", patient data will be forwarded between the departments and sub-areas of Gynaecological Endocrinology and Reproductive medicine, Gynaecological Endoscopy, Andrology/Urology, Human Genetics and Psychosomatics as part of effective patient care.